Mark L. Ruffalo, LCSW, is a psychotherapist in private practice in Tampa, Florida, and serves as Assistant Professor of Psychiatry at the University of Central Florida College of Medicine and Adjunct Assistant Professor of Psychiatry at Tufts University School of Medicine.
His interests span psychoanalysis, phenomenological psychopathology, and psychiatric nosology, and he has attempted to bridge classic communication theory with object relations theory in understanding borderline personality disorder. He has advanced the hypothesis that borderline personality disorder is fundamentally a disorder of paradox or self-contradiction.
He trained at the University of Pittsburgh and its affiliated psychiatric hospital, the Columbia University Center for Psychoanalytic Training and Research (transference-focused psychotherapy), and the Gunderson Personality Disorders Institute at McLean Hospital (general psychiatric management). He has published previously in the American Journal of Psychotherapy, the Bulletin of the Menninger Clinic, and the Journal of Nervous and Mental Disease. He currently serves as Director of Psychotherapy Training at the UCF/HCA Orlando psychiatry residency program and is Founding Editor of The Carlat Psychotherapy Report.
In this lecture, Mark L. Ruffalo, LCSW, will present a contemporary psychodynamic reformulation of borderline personality disorder through the lens of paradox and double bind communication. Drawing upon classic communication theory, object relations, and emerging empirical findings, he will argue that contradictory and entrapping early relational experiences become internalized as structural features of the borderline personality.
The workshop will explore how paradox functions as an organizing principle in BPD—shaping development, subjective experience, interpersonal life, and the transference–while offering clinicians a coherent framework for understanding the seemingly contradictory behaviors that often challenge therapeutic work.
Participants will learn how early double bind dilemmas are enacted in the treatment relationship, how these patterns differ from ordinary “no-win situations”, and how psychoanalytic technique can address the underlying “need-fear” dilemma without reenacting the patient’s internal paradox. Clinical implications for containment, interpretation, and their clinician’s therapeutic stance will be discussed, with an emphasis on restoring meaning and intelligibility to borderline phenomena.
Identify and describe the core features of double bind communication and explain how paradoxical relational patterns contribute to the developmental origins and clinical manifestations of the borderline personality disorder.
Recognize how double bind dynamics and the underlying “need-fear dilemma” are reenacted within the analytic relationship, including the ways in which patients place clinicians in contradictory interpersonal positions.
Apply psychoanalytic concepts and techniques to address paradoxical communications in treatment, enhancing the therapist’s capacity to contain contradictory transferential demands, avoid countertransferential entrapments, and facilitate integration of split self- and object representations.
3 CE Hours
Instructional level: intermediate
This workshop is available for all levels of participants.
This program is co-sponsored by Rutgers Graduate School of Applied and Professional Psychology. Rutgers Graduate School of Applied & Professional Psychology is approved by the American Psychological Association to sponsor continuing education for psychologists. Rutgers Graduate School of Applied & Professional Psychology maintains responsibility for this program and its content.

Rutgers Graduate School of Applied and Professional Psychology (GSAPP) is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0123.

Programs approved by the American Psychological Association are acceptable sources of continuing education credits. Please see https://www.njconsumeraffairs.gov/regulations/Chapter-34-Subchapters-10-31-Professional-Counselors.pdf, Section: 13:34-15.4 APPROVAL OF COURSES OR PROGRAMS on page 27. For all other professional licenses and certifications, please reference your issuing state board regulations regarding reciprocity of continuing education credits.
NJI has been approved by NBCC as an approved continuing education provider, ACEP No. 5822. Programs that do not qualify for NBCC credits are clearly identified. NJI is solely responsible for all aspects of the program.

This program is co-sponsored by The New Jersey Society for Clinical Social Work, which provides leadership and support to clinical social workers in all practice settings. The New Jersey Society for Clinical Social Work has given voice to clinical social workers dealing with the healthcare industry. The organization provides outstanding continuing education programs and opportunities for collegial contact.

NJI is an approved entity to provide CE for New Jersey Psychoanalysts. NJI is an ABAP accredited institution.
![]()
Cancellations submitted 72 hours (3 days) before the event will be charged a $25.00 administrative fee and the remaining balance will be refunded. Cancellations submitted less than 72 hours before the event will receive a 50% refund. No refunds will be given for same-day cancellations.
There is no potential conflict of interest and/or commercial support for this continuing education event.
The last day to register for this workshop is 4/9/26
For more information or to register visit us online www.njinstitute.com or email us at info@njinstitute.com
We are committed to fostering an inclusive learning environment. We value and respect diversity across racial and cultural identity and background, nationality, sexual and affectional orientation, gender identity and expression, religious background and belief, marital status, family structure, age, mental and physical health and ability, political perspective, and educational and class status.

